经皮椎体后凸成形术治疗胸腰段OVCF临床研究  

Effect Analysis on Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures of Thoracic-lumbar Vertebrae

作　　者：武文[1] 李强[1] 李如求[1] 

机构地区：[1]湖南省第二人民医院脊柱外科,长沙410007

出　　处：《中国现代手术学杂志》2015年第4期289-293,共5页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨经皮椎体后凸成形术（percutaneous kyphoplasty,PKP）治疗胸腰段OVCF的疗效。方法 2012年12月-2014年4月对54例胸腰段骨质疏松性椎体压缩性骨折患者共57个椎体行PKP手术治疗,其中A组26例27个椎体,术后X线正位片显示骨水泥弥散接近或刚过椎体中线,B组28例30个椎体,术后X线正位片显示骨水泥弥散范围超过3/4椎体,比较两组骨水泥的注射量、术后伤椎增加高度、术后1年伤椎丢失高度、术后24 h疼痛模拟评分（VAS）改善率及骨水泥渗漏情况。结果 A、B两组患者骨水泥注射量分别为（3.5±0.7）ml和（5.1±0.4）ml,术后1年伤椎丢失高度分别为（2.0±0.7）mm和（0.9±0.4）mm,术后24 h VAS改善率分别为65%±6%和74%±7%,组间比较差异均有统计学意义（P〈0.05）;A、B两组术后伤椎增加高度分别为（7.8±2.7）mm和（8.0±2.5）mm,组间比较无统计学差异（P〉0.05）。A组无骨水泥渗漏,B组骨水泥渗漏共2例2个椎体,其中椎间隙、椎旁渗漏各1例。结论 PKP是治疗胸腰段骨质疏松性椎体压缩性骨折的有效方法,单侧穿刺骨水泥的推注量应控制在4.5-5.5 ml左右（不宜超过6.0 ml）,并配合安全合理的穿刺操作,可使骨水泥在椎体内充分弥散,有效止痛,术后椎体高度不易丢失,较少发生骨水泥渗漏。Objective To explore the effect of percutaneous kyphoplasty（ PKP） in the treatment of osteoporotic vertebral compression fracture（ OVCF） of thoracic-lumbar vertebrae. Methods From December 2012 to April 2014,a total of 54 cases（ 54 vertebras） suffered OVCF of thoracic-lumbar vertebrae treated by PKP were analyzed retrospectively. According to dispersive range of injected bone cement in the postoperative posteroanterior image,they were divided into two groups： group A（ 26 cases,27 vertebras） showed the bone cement diffused near or over the vertebral midline,and group B（ 28 cases,30 vertebras） showed the bone cement diffused across 3 /4 of the vertebrae. The intra-operative injective volume,the enlarge height of injured vertebrae after surgery,lost height 1-year after the operative and the improvement rate of VAS 24 hour after the operation were compared between two groups. Results The injection volume,injured vertebrae height loss 1-year after the operative,and VAS improvement rate was（ 3. 5 ± 0. 7） ml,（ 2. 0 ± 0. 7） mm and 65% ± 6% respectively in group A,and was（ 5. 1 ± 0. 4） ml,（ 0. 9 ± 0. 4） mm and 74% ± 7% respectively in group B.There was statistic difference between two groups（ P 〈0. 05）. No statistic difference was found in the enlarge height of injured vertebrae between two groups（（ 7. 8 ± 2. 7） mm vs.（ 8. 0 ± 2. 5） mm,P 〉0. 05）. Cement Leakage occurred in 2 cases of group B,including intervertebral space and paravertebral leakage for each.Conclusion The procedure of PKP is an effective therapy for thoracic-lumbar OVCF with the volume of cement unilateral injection ranged from 4. 5 to 5. 5 ml,so it would achieve sufficient diffusion of cement,valid analgesia,stable vertebrae height and less cement leakage.

关 键 词：经皮椎体后凸成形术 脊椎骨折 胸腰椎 骨质疏松 

分 类 号：R687.3[医药卫生—骨科学]